Coma of Multiple Origin, Including Brain Abscess

Abstract

The comatose patient presents a challenging diagnostic and therapeutic problem to the physician. An adequate history is often lacking. We must, therefore, utilize both clinical impressions and laboratory facilities. In most cases, the diagnosis is obtainable if sufficient time exists. Time is therefore our principal limiting factor. We must establish the diagnosis while the changes produced during the comatose state are still reversible. The irreversible conditions are generally those which produce discernible structural changes of the brain. Any condition may become irreversible if allowed to persist for an appreciable period of time. This period of time may be only a few minutes in some cases, whereas in others it may be a matter of many days. The key to establishing an early diagnosis lies in the awareness of the possibilities. Inspection of the groups of conditions characterized by unconsciousness reveals a wide range of pathologic, physiologic, and psychologic processes that